The present disclosure pertains to medical devices and methods for manufacturing medical devices. More particularly, the present disclosure pertains to stent delivery systems that include an attachment mechanism for securing a stent.
A wide variety of intracorporeal medical devices have been developed for medical use, for example, intravascular use. Some of these devices include guidewires, catheters, and the like. These devices are manufactured by any one of a variety of different manufacturing methods and may be used according to any one of a variety of methods. Of the known medical devices and methods, each has certain advantages and disadvantages. There is an ongoing need to provide alternative medical devices as well as alternative methods for manufacturing and using medical devices.
The invention provides design, material, manufacturing method, and use alternatives for medical devices. An example stent delivery system may include a guide catheter. A push catheter may be slidably disposed over the guide catheter. A stent may be slidably disposed over the guide catheter and disposed adjacent to a distal end of the push catheter. A cantilever may be coupled to the push catheter.
Another example stent delivery system may include a guide catheter. A push catheter may be slidably disposed over the guide catheter. A stent may be slidably disposed over the guide catheter and disposed adjacent to a distal end of the push catheter. The stent may have an opening formed therein. A beam may be attached to the push catheter. The beam may be configured to shift between a first engaged configuration where the beam is engaged with the opening in the stent and a second unengaged configuration.
An example method of delivering a stent within a body lumen of a patient may include providing a stent delivery system. The stent delivery system may include a guide catheter. A push catheter may be slidably disposed over the guide catheter. A stent may be slidably disposed over the guide catheter and disposed adjacent to a distal end of the push catheter. The stent having an opening formed therein. A beam may be attached to the push catheter. The beam is configured to shift between a first engaged configuration where the beam is engaged with the opening in the stent and a second unengaged configuration. The method may include advancing the stent delivery system through a body lumen to a position adjacent to an area of interest. The method may include proximally retracting the guide catheter relative to the push catheter to shift the beam from the first configuration to the second configuration.
The above summary of some embodiments is not intended to describe each disclosed embodiment or every implementation of the present invention. The Figures, and Detailed Description, which follow, more particularly exemplify these embodiments.
The invention may be more completely understood in consideration of the following detailed description of various embodiments of the invention in connection with the accompanying drawings, in which:
While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention.
For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification.
All numeric values are herein assumed to be modified by the term “about,” whether or not explicitly indicated. The term “about” generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the terms “about” may include numbers that are rounded to the nearest significant figure.
The recitation of numerical ranges by endpoints includes all numbers within that range (e.g. 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).
As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise.
The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.
A wide variety of biliary, endoscopic, and/or endosurgical procedures have been developed for making medical treatments, diagnoses, and images of areas along the biliary tract and/or the pancreatic tract. For the purposes of this disclosure, the “biliary tract” and/or the “pancreatic tract” are understood to include various components of the digestive system and include, for example, the various ducts of the biliary tree between the liver and the duodenum as well as the various ducts between the pancreas and the duodenum. Numerous endoscopic and/or endosurgical devices have been developed for making medical treatments, diagnoses, and images of areas along the biliary and pancreatic tracts. Some of these device and/or procedures include biliary catheters, biliary guidewires, biliary stent delivery systems, drainage of the bile duct, splinting of the bile duct during healing, providing bile duct patency in a stricture or past a stone, and the like. In general, these devices are guided to the biliary and/or pancreatic tract by an endoscope (and/or a duodenoscope) that is disposed in the duodenum. Once positioned, various interventions can be performed depending on the needs of the patient and the type of device utilized. Other locations and/or uses are also contemplated for the systems disclosed herein including, for example, urinary tract interventions and/or urological interventions, gynecological interventions, etc.
When delivering a stent such as a drainage stent to the appropriate position within the anatomy, it may be desirable to hold or secure the position of the stent relative to a push catheter, which may be part of the stent delivery system. This allows the clinician to position and deploy the stent accurately at the intended location. One way that the stent may be secured to the push catheter may be with the use of a suture. Conventionally when a suture is utilized to secure a stent to a push catheter, the suture is formed into a loop that is wrapped around the guide catheter (which may extend through the lumen of the push catheter). The suture then extends through one of the barbed openings or flaps formed in the stent and it may be pulled snugly and attached or tied to the end of the push catheter, for example at a hole or opening formed at the distal end of the push catheter. As long as the position of the guide catheter is held stationary relative to the push catheter, this arrangement holds the position of the stent and effectively secures the stent to the push catheter. To release the stent, the guide catheter can be proximally retracted to a point where it exits and is disposed proximally of the loop formed in the suture. When no longer wrapped around the guide catheter, the loop or looped end of the suture is free to simply exit the opening at the barbed flap of the stent such that the stent is released from the push catheter.
Disclosed herein are a number of delivery systems for delivering a stent (e.g., a drainage stent) to an appropriate position within the anatomy. The delivery systems may use an attachment mechanism to secure the position of the stent relative to a push member or catheter. The attachment mechanism may allow a clinician to selectively “lock” and “unlock” a stent to the push catheter so that the stent can be accurately deployed to a target site. The use of the attachment mechanism disclosed herein may be desirable for a number of reasons. For example, the attachment mechanism disclosed herein allows the deployment of a stent while the guidewire is left in place. This allows the clinician to maintain guidewire access within the anatomy throughout the intervention. In addition, the attachment mechanism disclosed herein may allow a clinician to deploy and/or reposition the stent multiple times with just one system. Additionally, the attachment mechanism may be formed from materials that allow for improved visualization at the treatment including radiopaque materials. Moreover, the attachment mechanism disclosed herein may help control or otherwise fix the distance between the push catheter and the stent, which may increase the accuracy in deployment. Furthermore, the attachment mechanism disclosed herein may eliminate the need for sutures, which may be expensive and labor intensive to use. In addition, manufacturing the attachment mechanism disclosed herein (and/or the delivery systems incorporating the attachment mechanism) may be possible in an automated or semi-automated manner so that manufacturing costs can be reduced. These are just examples. Some additional details regarding these and other features are provided below.
Referring now to
The delivery system 10 may be designed for use with a conventional guidewire 2 and may include a guide catheter 12, a delivery or push catheter 14, and a handle assembly 16. The guidewire 2 may extend into a lumen 22 of the guide catheter 12, through a distal guidewire port 24, and out a proximal guidewire port 26 formed in a sidewall of the push catheter 14, providing the delivery system 10 with single-operator-exchange (SOE) capabilities. Other embodiments are also contemplated, however, where the delivery system 10 is an over-the-wire (OTW) system.
The guide catheter 12 may be slidably disposed within the lumen 28 of the push catheter 14 and may extend distally from the distal end of the push catheter 14. The stent 20 may be positioned on a distal portion of the guide catheter 12, which may be located distal of the push catheter 14, and the stent 20 may abut or otherwise be disposed adjacent to the distal end 30 of the push catheter 14. When the stent 20 has been properly placed, the stent 20 may be disconnected from the push catheter 14 such that the stent 20 remains in the anatomy or body lumen when the push catheter 14 is withdrawn.
The proximal end 32 of the push catheter 14 may be attached to the handle assembly 16. For example, the proximal end 32 may include a female luer lock connector 34 threadably coupled to a threaded male connector 36 of the handle assembly 16. It may be understood, however, that the push catheter 14 may be attached to the handle assembly 16 and extend distally therefrom by other means, such as adhesive bonding, welding, friction fit, interlocking fit, or other suitable means.
The guide catheter 12 may include a distal tubular portion 38 and a proximal elongate wire 40, such as a pull wire, coupled to the distal tubular portion 38. In some instances, the elongate wire 40 may be a wire, filament, thread, portion of a catheter wall, fabric, web, or similar elongate structure. The elongate wire 40 may be coupled to the distal tubular portion 38 at a rotatable connection that may allow rotatable movement between the tubular portion 38 and the elongate wire 40 of the guide catheter 12. The elongate wire 40 may extend through the lumen 28 of the push catheter 14 to the handle assembly 16. In some embodiments, the elongate wire 40 may extend through the handle assembly 16 to a location proximal of the handle assembly 16. The proximal end of elongate wire 40 may terminate at a knob 42 which may be grasped by an operator to manipulate the guide catheter 12.
As shown in
The stent 20 may include one or more anchors 46 that are generally disposed near an opening 50 in the stent 20. Anchors 46, for example, may project radially outward from the stent 20 and help to secure or “anchor” the position of the stent 20 within the anatomy when deployed. In at least some embodiments, the anchors 46 are defined by a skived cut in the stent 20 and take the form of a barb or barb-like flap. Other configurations are contemplated.
As indicated above, the system 10 may also include an attachment mechanism 44. In general, the attachment mechanism may be configured to secure the position of the stent 20 relative to the push catheter 14. To do so, the attachment mechanism 44 may have a portion that extends through a hole or opening 45 formed in the stent 20. Note that in some cases, the hole or opening 45 may be positioned proximally from the barb openings 50 in the stent 20. In other embodiments, however, the attachment mechanism 44 may engage one of the barb openings 50, thereby reducing or eliminating the need for dedicated openings 45. In some embodiments, the hole 45 extends through the wall of the stent 20 while in others the hole 45 may extend through only a portion of the wall of the stent 20 or otherwise take the form of a groove.
The example attachment mechanism 44 may include a generally cylindrical base 52 and a beam or cantilever 54 extending from the base 52 as shown in
Note that in some cases, the attachment mechanism 44 may be omitted completely. In at least some of these cases, a cantilever or beam (e.g., which may be similar to the cantilever 54) may extend from the stent 20 toward the guide catheter 12, or may extend from the guide catheter 12 toward the stent 20, without the use of an attachment mechanism 44. In some cases, the cantilever or beam may be a wire with an upward bend.
The attachment mechanism 44 may be formed in any suitable manner. For example, the attachment mechanism 44 may be formed from a metal tube or cannula that is cut by punch and die tooling, laser cutting, electron discharge machining, or other suitable techniques. Alternatively, the attachment mechanism may be thermoformed by injection molding. These are just examples as other forming techniques are contemplated.
The size, shape, and/or configuration of the attachment mechanism 44 may also improve the accuracy of stent 20 deployment. For example, because the cantilever 54 may have an essentially constant length and because the base 52 may be fixed to the push catheter 14, the precise position of the stent 20 relative to the push catheter 14 may be known. This controls the distance between the stent 20 and the push catheter 14 using the dimensionally controlled cantilever 54. Because of this, the clinician may be able to reliably determine where the stent 20 is located based on the position of the push catheter 14. Moreover, if the attachment mechanism 44 includes a radiopaque material, fluoroscopic visualization may also be relied upon to accurately determine the position of the stent 20.
The cantilever 54 may have a fixed proximal end 58, which is fixed to the cylindrical base 52, and may have a free distal end 60 that extends away from the fixed proximal end 58. In this example, the cylindrical base 52 may include a longitudinal notch 62 extending proximally from a distal edge of the cylindrical base 52, with the cantilever 54 extending distally from a proximal edge of the notch 62. The base 52 may form a support wall that allows the stent 20 to be better aligned and supported by the attachment mechanism 44. The cantilever 54 may extend substantially parallel to a longitudinal axis of the guide catheter 12.
The cantilever 54 may be configured to shift between a first or “locked configuration” and a second or “unlocked” configuration. When in the locked configuration, the cantilever 54 may be oriented so that the distal end 60 projects into or otherwise engages the opening 45 in the stent 20 such that the stent 20 is substantially “locked” or otherwise fixed to the push catheter 14. When in the unlocked configuration, the cantilever 54 shifts (e.g., radially inward) so that the distal end 60 disengages from the opening 45 in the stent 20 such that the stent 20 is no longer fixed to the push catheter 14.
The cantilever 54 may form a hinge or pivot point adjacent to the proximal end 58 that allows the cantilever 54 to move, for example, radially outward and inward. For example, the cantilever 54 may be pre-bent or curved radially inward. In at least some embodiments, the cantilever 54 may be biased to be in this pre-bent configuration. This may correspond to the unlocked configuration. The cantilever 54 may be shifted between the locked and unlocked configuration by the guide catheter 12. For example, when the guide catheter 12 is passed through the attachment mechanism 44, the guide catheter 12 may engage and urge radially outward the cantilever 54 and, thus, shifts it to the locked configuration as shown in
Because the configuration of the cantilever 54 may be altered by movement of the guide catheter 12, the clinician may have control of the stent 20 and may be able to hold/secure the stent 20 and then release/deploy the stent 20 “on demand”. In addition, because shifting of the cantilever 54 is accomplished through movement of the guide catheter 12, the guidewire 2 can be left in place during deployment of the stent 20, which provides greater flexibility for the clinician because access to the appropriate location in the anatomy can be maintained throughout the intervention.
The attachment mechanism 44 may be made of any suitable materials including any of those disclosed herein. For example, the attachment mechanism 44 may be made from stainless steel, nitinol, tantalum, and tungsten. Alternatively, the attachment mechanism 44 may be made from a polymer including, for example, PEEK (polyetheretherketone), ABS (acrylonitrile-butadienestyrene), Nylon, Polyester, Ultem (PEI, or Polyether Imide), LCP (liquid crystal polymer), HDPE (high-density polyethylene) or LDPE (low-density polyethylene). These are just examples. In some cases, the attachment mechanism 44 may be made of or otherwise include a radiopaque material that can be viewed under fluoroscopy to aid in properly placing the stent 20.
In the examples disclosed herein, the attachment mechanisms 44/144 only include one cantilever or beam 54/154. This, however, is not intended to be limiting. Embodiments are contemplated where the attachment mechanism 44/144 includes more than one cantilever 54/154. For example, the attachment mechanism 44/144 may include two, three, four, five, six, or more cantilevers 54/154 arranged in any suitable manner. In these embodiments, the stent 20 may also include corresponding openings (e.g., similar to opening 45) for each of the cantilevers. In some cases, more than one cantilever may lock into the same hole or opening (e.g., the opening 45) in the stent 20. In some cases, the inclusion of two opposing cantilevers may allow the delivery system 10 to be used as a grasping device to remove and/or reposition stent 20. In addition, the distal end 60/160 of the cantilevers 54/154 may include a projection that projects radially inward, which may further improve the ability of the cantilevers 54/154 to remove and/or reposition the stent 20.
Note that cantilever 54 is not required to have any particular width or thickness. However, the geometry and material of cantilever 54 may be chosen to control the release of the stent 20. End 60 is not limited to the tab as shown. For instance, the end 60 may be a peg or bump, or may include more than one tab or peg.
In some cases, the cantilever may not be a solid element or beam, but may include one or more hollow portions that extend through the cantilever. For instance, the cantilever may include one or more holes that extend vertically through the cantilever. In some cases, the cantilever may be formed as a wire, extending longitudinally from the attachment mechanism, forming a loop that extends laterally and also extends vertically so that the vertical portion can engage the hole or groove in the stent, and then extends longitudinally to attach at its opposite end at the attachment mechanism. For these cases, the attachment points may be relatively close together so that the longitudinally extending portions are generally parallel, or may be relatively far apart so that the longitudinally extending portions include a lateral component. In other cases, the cantilever may be formed as a single wire that is only affixed to the attachment mechanism at one end, where the other end terminates at or near an upward-extending hook. These are just examples.
In some cases, the aspect ratio of the beam or cantilever 54 may be relatively close to 1:1, or may even include a larger width than length.
In some cases, the mating hole in the stent 20 may not extend fully through the stent 20, or may be formed as a groove rather than a hole.
As alluded to herein, the delivery system 10 and/or components thereof may be made from a metal, metal alloy, polymer (some examples of which are disclosed below), a metal-polymer composite, ceramics, combinations thereof, and the like, or other suitable material. Some examples of suitable metals and metal alloys include stainless steel, such as 304V, 304L, and 316LV stainless steel; mild steel; nickel-titanium alloy such as linear-elastic and/or super-elastic nitinol; other nickel alloys such as nickel-chromium-molybdenum alloys (e.g., UNS: N06625 such as INCONEL® 625, UNS: N06022 such as HASTELLOY® C-22®, UNS: N10276 such as HASTELLOY® C276®, other HASTELLOY® alloys, and the like), nickel-copper alloys (e.g., UNS: N04400 such as MONEL® 400, NICKELVAC® 400, NICORROS® 400, and the like), nickel-cobalt-chromium-molybdenum alloys (e.g., UNS: R30035 such as MP35-N® and the like), nickel-molybdenum alloys (e.g., UNS: N10665 such as HASTELLOY® ALLOY B2®), other nickel-chromium alloys, other nickel-molybdenum alloys, other nickel-cobalt alloys, other nickel-iron alloys, other nickel-copper alloys, other nickel-tungsten or tungsten alloys, and the like; cobalt-chromium alloys; cobalt-chromium-molybdenum alloys (e.g., UNS: R30003 such as ELGILOY®, PHYNOX®, and the like); platinum enriched stainless steel; titanium; combinations thereof; and the like; or any other suitable material.
Some examples of suitable polymers may include polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, for example, DELRIN® available from DuPont), polyether block ester, polyurethane (for example, Polyurethane 85A), polypropylene (PP), polyvinylchloride (PVC), polyether-ester (for example, ARNITEL® available from DSM Engineering Plastics), ether or ester based copolymers (for example, butylene/poly(alkylene ether) phthalate and/or other polyester elastomers such as HYTREL® available from DuPont), polyamide (for example, DURETHAN® available from Bayer or CRISTAMID® available from Elf Atochem), elastomeric polyamides, block polyamide/ethers, polyether block amide (PEBA, for example available under the trade name PEBAX®), ethylene vinyl acetate copolymers (EVA), silicones, polyethylene (PE), Marlex high-density polyethylene, Marlex low-density polyethylene, linear low density polyethylene (for example REXELL®), polyester, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyetheretherketone (PEEK), polyimide (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), poly paraphenylene terephthalamide (for example, KEVLAR®), polysulfone, nylon, nylon-12 (such as GRILAMID® available from EMS American Grilon), perfluoro(propyl vinyl ether) (PFA), ethylene vinyl alcohol, polyolefin, polystyrene, epoxy, polyvinylidene chloride (PVdC), poly(styrene-b-isobutylene-b-styrene) (for example, SIBS and/or SIBS 50A), polycarbonates, ionomers, biocompatible polymers, other suitable materials, or mixtures, combinations, copolymers thereof, polymer/metal composites, and the like. In some embodiments the polymer can be blended with a liquid crystal polymer (LCP). For example, the mixture can contain up to about 6 percent LCP.
In at least some embodiments, portions or all of the tubular member(s) may also be doped with, made of, or otherwise include a radiopaque material. Radiopaque materials are understood to be materials capable of producing a relatively bright image on a fluoroscopy screen or another imaging technique during a medical procedure. This relatively bright image aids the user of tubular member in determining its location. Some examples of radiopaque materials can include, but are not limited to, gold, platinum, palladium, tantalum, tungsten alloy, polymer material loaded with a radiopaque filler, and the like. Additionally, other radiopaque marker bands and/or coils may also be incorporated into the design of the tubular member to achieve the same result.
In some embodiments, a degree of Magnetic Resonance Imaging (MRI) compatibility is imparted into the tubular member. For example, the tubular member, or portions thereof, may be made of a material that does not substantially distort the image and create substantial artifacts (i.e., gaps in the image). Certain ferromagnetic materials, for example, may not be suitable because they may create artifacts in an MRI image. The tubular member, or portions thereof, may also be made from a material that the MRI machine can image. Some materials that exhibit these characteristics include, for example, tungsten, cobalt-chromium-molybdenum alloys (e.g., UNS: R30003 such as ELGILOY®, PHYNOX®, and the like), nickel-cobalt-chromium-molybdenum alloys (e.g., UNS: R30035 such as MP35-N® and the like), nitinol, and the like, and others.
In some embodiments, a coating, for example a lubricious, a hydrophilic, a protective, or other type of coating may be applied over portions or all of the delivery system or components thereof. Hydrophobic coatings such as fluoropolymers provide a dry lubricity which improves device handling and device exchanges. Lubricious coatings improve steerability and improve lesion crossing capability. Suitable lubricious polymers are well known in the art and may include silicone and the like, hydrophilic polymers such as high-density polyethylene (HDPE), polytetrafluoroethylene (PTFE), polyarylene oxides, polyvinylpyrolidones, polyvinylalcohols, hydroxy alkyl cellulosics, algins, saccharides, caprolactones, and the like, and mixtures and combinations thereof. Hydrophilic polymers may be blended among themselves or with formulated amounts of water insoluble compounds (including some polymers) to yield coatings with suitable lubricity, bonding, and solubility. Some other examples of such coatings and materials and methods used to create such coatings can be found in U.S. Pat. Nos. 6,139,510 and 5,772,609, which are incorporated herein by reference.
The arrangement of the various structures of the delivery system 10 may vary. In some embodiments, the system 10 may include any of the structures or utilize any of the arrangements of structures that are disclosed in U.S. Pat. Nos. 5,152,749; 5,334,185; 5,921,952; 6,248,100; 6,264,624; and 6,562,024, the entire disclosures of which are herein incorporated by reference. In addition, U.S. Patent Application Ser. No. 61/415,660, filed Nov. 19, 2010, is also herein incorporated by reference.
It should be understood that this disclosure is, in many respects, only illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of steps without exceeding the scope of the invention. The invention's scope is, of course, defined in the language in which the appended claims are expressed.
This application claims priority under 35 U.S.C. § 119 to U.S. Provisional Application Ser. No. 61/501,387, filed Jun. 27, 2011, the entirety of which is incorporated herein by reference.
Number | Name | Date | Kind |
---|---|---|---|
1204053 | Moore | Nov 1916 | A |
2212334 | Wallerich | Aug 1940 | A |
2393003 | Smith | Jan 1946 | A |
2623520 | Bamford, Jr. et al. | Dec 1952 | A |
3015869 | Rapata | Jan 1962 | A |
3100490 | Desautels | Aug 1963 | A |
3332424 | Minteer | Jul 1967 | A |
3421509 | Fiore | Jan 1969 | A |
3460541 | Doherty | Aug 1969 | A |
3536281 | Meehan et al. | Oct 1970 | A |
3592197 | Cohen | Jul 1971 | A |
3707151 | Jackson | Dec 1972 | A |
3783453 | Bolie | Jan 1974 | A |
3889686 | Duturbure | Jun 1975 | A |
3890977 | Wilson | Jun 1975 | A |
3908635 | Viek | Sep 1975 | A |
3938529 | Gibbons | Feb 1976 | A |
3970089 | Saice | Jul 1976 | A |
3995642 | Adair | Dec 1976 | A |
4194513 | Rhine et al. | Mar 1980 | A |
4212304 | Finney | Jul 1980 | A |
4225979 | Rey et al. | Oct 1980 | A |
4242304 | Ryder | Dec 1980 | A |
4248214 | Hannah et al. | Feb 1981 | A |
4299226 | Banka | Nov 1981 | A |
4307723 | Finney | Dec 1981 | A |
4334327 | Lyman et al. | Jun 1982 | A |
4345606 | Littleford | Aug 1982 | A |
4364392 | Strother et al. | Dec 1982 | A |
4382445 | Sommers | May 1983 | A |
4411654 | Boarini et al. | Oct 1983 | A |
4412832 | Kling et al. | Nov 1983 | A |
4413989 | Schjeldahl et al. | Nov 1983 | A |
4423725 | Baran et al. | Jan 1984 | A |
4425919 | Alston, Jr. et al. | Jan 1984 | A |
4434797 | Silander | Mar 1984 | A |
4445892 | Hussein et al. | May 1984 | A |
4474569 | Newkirk | Oct 1984 | A |
4484585 | Baier | Nov 1984 | A |
4500313 | Young | Feb 1985 | A |
RE31855 | Osborne | Mar 1985 | E |
4531933 | Norton et al. | Jul 1985 | A |
4545373 | Christoudias | Oct 1985 | A |
4554929 | Samson et al. | Nov 1985 | A |
4568338 | Todd | Feb 1986 | A |
4573470 | Samson et al. | Mar 1986 | A |
4581017 | Sahota | Apr 1986 | A |
4582181 | Samson | Apr 1986 | A |
4592341 | Omagari et al. | Jun 1986 | A |
4606347 | Fogarty et al. | Aug 1986 | A |
4610657 | Densow | Sep 1986 | A |
4616653 | Samson et al. | Oct 1986 | A |
4641654 | Samson et al. | Feb 1987 | A |
4643716 | Drach | Feb 1987 | A |
4645493 | Ferrando et al. | Feb 1987 | A |
4646742 | Packard et al. | Mar 1987 | A |
4654025 | Cassou et al. | Mar 1987 | A |
4655746 | Daniels et al. | Apr 1987 | A |
4655771 | Wallsten | Apr 1987 | A |
4671795 | Mulchin | Jun 1987 | A |
4684369 | Wildemeersch | Aug 1987 | A |
4696668 | Wilcox | Sep 1987 | A |
4699611 | Bowden | Oct 1987 | A |
4713049 | Carter | Dec 1987 | A |
4723550 | Bales et al. | Feb 1988 | A |
4738667 | Galloway | Apr 1988 | A |
4747833 | Kousai et al. | May 1988 | A |
4748982 | Horzewski et al. | Jun 1988 | A |
4755175 | Nilsson | Jul 1988 | A |
4762128 | Rosenbluth | Aug 1988 | A |
4762129 | Bonzel | Aug 1988 | A |
4763654 | Jang | Aug 1988 | A |
4771777 | Horzewski et al. | Sep 1988 | A |
4781677 | Wilcox | Nov 1988 | A |
4783454 | Liu | Nov 1988 | A |
4784651 | Hickey | Nov 1988 | A |
4787884 | Goldberg | Nov 1988 | A |
4790315 | Mueller, Jr. et al. | Dec 1988 | A |
4790809 | Kuntz | Dec 1988 | A |
4790810 | Pugh, Jr. et al. | Dec 1988 | A |
4798193 | Giesy et al. | Jan 1989 | A |
4798594 | Hillstead | Jan 1989 | A |
4813925 | Anderson, Jr. et al. | Mar 1989 | A |
4813934 | Engelson et al. | Mar 1989 | A |
4817613 | Jaraczewski et al. | Apr 1989 | A |
4819751 | Shimada et al. | Apr 1989 | A |
4820262 | Finney | Apr 1989 | A |
4822333 | Lavarenne | Apr 1989 | A |
4824435 | Giesy et al. | Apr 1989 | A |
4832055 | Palestrant | May 1989 | A |
4835824 | Durham et al. | Jun 1989 | A |
4838268 | Keith et al. | Jun 1989 | A |
4844092 | Rydell et al. | Jul 1989 | A |
4846174 | Willard et al. | Jul 1989 | A |
4846193 | Tremulis et al. | Jul 1989 | A |
4848343 | Wallsten et al. | Jul 1989 | A |
4848344 | Sos et al. | Jul 1989 | A |
4874360 | Goldberg et al. | Oct 1989 | A |
4877031 | Conway et al. | Oct 1989 | A |
4886065 | Collins, Jr. | Dec 1989 | A |
4892519 | Songer et al. | Jan 1990 | A |
4898577 | Badger et al. | Feb 1990 | A |
4900184 | Cleveland | Feb 1990 | A |
4905667 | Foerster et al. | Mar 1990 | A |
4906241 | Noddin et al. | Mar 1990 | A |
4913141 | Hillstead | Apr 1990 | A |
4913683 | Gregory | Apr 1990 | A |
4917088 | Crittenden | Apr 1990 | A |
4917103 | Gambale et al. | Apr 1990 | A |
4917666 | Solar et al. | Apr 1990 | A |
4927418 | Dake et al. | May 1990 | A |
4928693 | Goodin et al. | May 1990 | A |
4931037 | Wetterman | Jun 1990 | A |
4932413 | Shockey et al. | Jun 1990 | A |
4932959 | Horzewski et al. | Jun 1990 | A |
4944745 | Sogard et al. | Jul 1990 | A |
4946443 | Hauser et al. | Aug 1990 | A |
4950228 | Knapp, Jr. et al. | Aug 1990 | A |
4955858 | Drews | Sep 1990 | A |
4955895 | Sugiyama et al. | Sep 1990 | A |
4957479 | Roemer | Sep 1990 | A |
4963129 | Rusch | Oct 1990 | A |
4964409 | Tremulis | Oct 1990 | A |
4967753 | Haase et al. | Nov 1990 | A |
4973301 | Nissenkorn | Nov 1990 | A |
4976720 | Machold et al. | Dec 1990 | A |
4983168 | Moorehead | Jan 1991 | A |
4986814 | Burney et al. | Jan 1991 | A |
4988356 | Crittenden et al. | Jan 1991 | A |
4990133 | Solazzo | Feb 1991 | A |
4990151 | Wallsten | Feb 1991 | A |
4994027 | Farrell | Feb 1991 | A |
4994066 | Voss | Feb 1991 | A |
4997421 | Palsrok et al. | Mar 1991 | A |
4998917 | Gaiser et al. | Mar 1991 | A |
4998923 | Samson et al. | Mar 1991 | A |
5002532 | Gaiser et al. | Mar 1991 | A |
5003990 | Osypka | Apr 1991 | A |
5007901 | Shields | Apr 1991 | A |
5015231 | Keith et al. | May 1991 | A |
5019085 | Hillstead | May 1991 | A |
5019102 | Hoene | May 1991 | A |
5026377 | Burton et al. | Jun 1991 | A |
5026607 | Kiezulas | Jun 1991 | A |
5031636 | Gambale et al. | Jul 1991 | A |
5032113 | Burns | Jul 1991 | A |
5035705 | Burns | Jul 1991 | A |
5040548 | Yock | Aug 1991 | A |
5042985 | Elliott et al. | Aug 1991 | A |
5045061 | Seifert et al. | Sep 1991 | A |
5046497 | Millar | Sep 1991 | A |
5047018 | Gay et al. | Sep 1991 | A |
5047045 | Arney et al. | Sep 1991 | A |
5052998 | Zimmon | Oct 1991 | A |
5057092 | Webster, Jr. | Oct 1991 | A |
5061267 | Zeiher | Oct 1991 | A |
5061273 | Yock | Oct 1991 | A |
5064414 | Revane | Nov 1991 | A |
5066285 | Hillstead | Nov 1991 | A |
5078681 | Kawashima | Jan 1992 | A |
5085636 | Burns | Feb 1992 | A |
5090958 | Sahota | Feb 1992 | A |
5098374 | Othel-Jacobsen et al. | Mar 1992 | A |
5114403 | Clarke et al. | May 1992 | A |
5116309 | Coll | May 1992 | A |
5120308 | Hess | Jun 1992 | A |
5125905 | Wright et al. | Jun 1992 | A |
5125915 | Berry et al. | Jun 1992 | A |
5135494 | Engelson et al. | Aug 1992 | A |
5135535 | Kramer | Aug 1992 | A |
5141502 | Macaluso, Jr. | Aug 1992 | A |
5141518 | Hess et al. | Aug 1992 | A |
5147370 | McNamara et al. | Sep 1992 | A |
5147377 | Sahota | Sep 1992 | A |
5152749 | Giesy et al. | Oct 1992 | A |
5154725 | Leopold | Oct 1992 | A |
5158545 | Trudell et al. | Oct 1992 | A |
5160321 | Sahota | Nov 1992 | A |
5160341 | Brenneman et al. | Nov 1992 | A |
5167634 | Corrigan, Jr. et al. | Dec 1992 | A |
5171221 | Samson | Dec 1992 | A |
5171222 | Euteneuer et al. | Dec 1992 | A |
5176637 | Sagae | Jan 1993 | A |
5180367 | Kontos et al. | Jan 1993 | A |
5181921 | Makita et al. | Jan 1993 | A |
5195978 | Schiffer | Mar 1993 | A |
5205822 | Johnson et al. | Apr 1993 | A |
5209728 | Kraus et al. | May 1993 | A |
5217434 | Arney | Jun 1993 | A |
5217482 | Keith | Jun 1993 | A |
5221260 | Burns et al. | Jun 1993 | A |
5232445 | Bonzel | Aug 1993 | A |
5234437 | Sepetka | Aug 1993 | A |
5242396 | Evard | Sep 1993 | A |
5248306 | Clark et al. | Sep 1993 | A |
5250033 | Evans et al. | Oct 1993 | A |
5250071 | Palermo | Oct 1993 | A |
5256144 | Kraus et al. | Oct 1993 | A |
5261916 | Engelson | Nov 1993 | A |
5267958 | Buchbinder et al. | Dec 1993 | A |
5277199 | DuBois et al. | Jan 1994 | A |
5279562 | Sirhan et al. | Jan 1994 | A |
5282479 | Havran | Feb 1994 | A |
5282784 | Willard | Feb 1994 | A |
5290232 | Johnson et al. | Mar 1994 | A |
5290241 | Kraus et al. | Mar 1994 | A |
5290247 | Crittenden | Mar 1994 | A |
5295954 | Sachse | Mar 1994 | A |
5300085 | Yock | Apr 1994 | A |
5304195 | Twyford, Jr. et al. | Apr 1994 | A |
5304198 | Samson | Apr 1994 | A |
5306247 | Pfenninger | Apr 1994 | A |
5308318 | Plassche, Jr. | May 1994 | A |
5320602 | Karpiel | Jun 1994 | A |
5320604 | Walker et al. | Jun 1994 | A |
5322501 | Mahmud-Durrani | Jun 1994 | A |
5324259 | Taylor et al. | Jun 1994 | A |
5324269 | Miraki | Jun 1994 | A |
5328468 | Kaneko et al. | Jul 1994 | A |
5334143 | Carroll | Aug 1994 | A |
5334185 | Giesy et al. | Aug 1994 | A |
5334187 | Fischell et al. | Aug 1994 | A |
5346467 | Coll | Sep 1994 | A |
5348537 | Wiesner et al. | Sep 1994 | A |
5350395 | Yock | Sep 1994 | A |
5354263 | Coll | Oct 1994 | A |
5360401 | Turnland | Nov 1994 | A |
5364340 | Coll | Nov 1994 | A |
5364354 | Walker et al. | Nov 1994 | A |
5364355 | Alden et al. | Nov 1994 | A |
5364376 | Horzewski et al. | Nov 1994 | A |
5370623 | Kreamer | Dec 1994 | A |
5370655 | Burns | Dec 1994 | A |
5372600 | Beyar et al. | Dec 1994 | A |
5382234 | Cornelius et al. | Jan 1995 | A |
5454790 | Dubrul | Jan 1995 | A |
5389087 | Miraki | Feb 1995 | A |
5391155 | Sachse | Feb 1995 | A |
5395335 | Jang | Mar 1995 | A |
5397302 | Weaver et al. | Mar 1995 | A |
5401257 | Chevalier, Jr. et al. | Mar 1995 | A |
5405378 | Strecker | Apr 1995 | A |
5407435 | Sachse | Apr 1995 | A |
5409468 | Sachse | Apr 1995 | A |
5425711 | Ressemann et al. | Jun 1995 | A |
5451233 | Yock | Sep 1995 | A |
5454788 | Walker et al. | Oct 1995 | A |
5456680 | Taylor et al. | Oct 1995 | A |
5458584 | Ginn et al. | Oct 1995 | A |
5458605 | Klemm | Oct 1995 | A |
5458613 | Gharibadeh et al. | Oct 1995 | A |
5458615 | Klemm et al. | Oct 1995 | A |
5470315 | Adams | Nov 1995 | A |
5476505 | Limon | Dec 1995 | A |
5480389 | McWha et al. | Jan 1996 | A |
5480434 | Eckstein et al. | Jan 1996 | A |
5484409 | Atkinson et al. | Jan 1996 | A |
5484444 | Braunschweiler et al. | Jan 1996 | A |
5489271 | Andersen | Feb 1996 | A |
5490837 | Blaeser et al. | Feb 1996 | A |
5496275 | Sirhan et al. | Mar 1996 | A |
5496344 | Kanesaka et al. | Mar 1996 | A |
5496346 | Horzewski et al. | Mar 1996 | A |
5501227 | Yock | Mar 1996 | A |
5507768 | Lau et al. | Apr 1996 | A |
5531700 | Moore et al. | Jul 1996 | A |
5533968 | Muni et al. | Jul 1996 | A |
5536248 | Weaver et al. | Jul 1996 | A |
5540236 | Ginn | Jul 1996 | A |
5545134 | Hilaire et al. | Aug 1996 | A |
5545138 | Fugoso et al. | Aug 1996 | A |
5549552 | Peters et al. | Aug 1996 | A |
5569201 | Burns | Oct 1996 | A |
5578009 | Kraus et al. | Nov 1996 | A |
5599291 | Balbierz et al. | Feb 1997 | A |
5599299 | Weaver et al. | Feb 1997 | A |
5599300 | Weaver et al. | Feb 1997 | A |
5626600 | Horzewski et al. | May 1997 | A |
5639274 | Fischell et al. | Jun 1997 | A |
5643278 | Wijay | Jul 1997 | A |
5645533 | Blaeser et al. | Jul 1997 | A |
5653748 | Strecker | Aug 1997 | A |
5669880 | Solar | Sep 1997 | A |
5676654 | Ellis et al. | Oct 1997 | A |
5681274 | Perkins et al. | Oct 1997 | A |
5690642 | Osborne et al. | Nov 1997 | A |
5690644 | Yurek et al. | Nov 1997 | A |
5693015 | Walker et al. | Dec 1997 | A |
5695468 | Lafontaine et al. | Dec 1997 | A |
5702439 | Keith et al. | Dec 1997 | A |
5706827 | Ehr et al. | Jan 1998 | A |
5709703 | Lukic et al. | Jan 1998 | A |
5725504 | Collins | Mar 1998 | A |
5743874 | Fischell et al. | Apr 1998 | A |
5772609 | Nguyen et al. | Jun 1998 | A |
5776099 | Tremulis | Jul 1998 | A |
5782855 | Lau et al. | Jul 1998 | A |
5788681 | Weaver et al. | Aug 1998 | A |
5800414 | Cazal | Sep 1998 | A |
5833706 | St. Germain et al. | Nov 1998 | A |
5843028 | Weaver et al. | Dec 1998 | A |
5849016 | Suhr | Dec 1998 | A |
5921952 | Desmond, III et al. | Jul 1999 | A |
5921971 | Agro et al. | Jul 1999 | A |
5947927 | Mertens | Sep 1999 | A |
5980533 | Holman | Nov 1999 | A |
6007522 | Agro et al. | Dec 1999 | A |
6059752 | Segal | May 2000 | A |
6077295 | Limon et al. | Jun 2000 | A |
6095990 | Parodi | Aug 2000 | A |
6096009 | Windheuser et al. | Aug 2000 | A |
6113607 | Lau et al. | Sep 2000 | A |
6139510 | Palermo | Oct 2000 | A |
6152910 | Agro et al. | Nov 2000 | A |
6159195 | Ha et al. | Dec 2000 | A |
6248100 | de Toledo et al. | Jun 2001 | B1 |
6264624 | Desmond, III et al. | Jul 2001 | B1 |
6309379 | Willard et al. | Oct 2001 | B1 |
6346093 | Allman et al. | Feb 2002 | B1 |
6380457 | Yurek et al. | Apr 2002 | B1 |
6394141 | Wages et al. | May 2002 | B2 |
6398799 | Kramer | Jun 2002 | B2 |
6475187 | Gerberding | Nov 2002 | B1 |
6488694 | Lau et al. | Dec 2002 | B1 |
6527789 | Lau et al. | Mar 2003 | B1 |
6562024 | Alvarez de Toledo et al. | May 2003 | B2 |
6582401 | Windheuser et al. | Jun 2003 | B1 |
6582459 | Lau et al. | Jun 2003 | B1 |
6592549 | Gerdts et al. | Jul 2003 | B2 |
6723071 | Gerdts et al. | Apr 2004 | B2 |
6743217 | Rowland et al. | Jun 2004 | B2 |
6764484 | Richardson et al. | Jul 2004 | B2 |
6858034 | Hijlkema et al. | Feb 2005 | B1 |
6890317 | Gerdts et al. | May 2005 | B2 |
7001358 | Fitzmaurice et al. | Feb 2006 | B2 |
7115109 | Gerdts et al. | Oct 2006 | B2 |
7468053 | Gerdts et al. | Dec 2008 | B2 |
7550002 | Goto et al. | Jun 2009 | B2 |
7815601 | Jordan et al. | Oct 2010 | B2 |
20020029076 | Yee | Mar 2002 | A1 |
20040093061 | Acosta et al. | May 2004 | A1 |
20050085891 | Goto et al. | Apr 2005 | A1 |
20050085892 | Goto et al. | Apr 2005 | A1 |
20060276873 | Sato | Dec 2006 | A1 |
20070282436 | Pinchuk | Dec 2007 | A1 |
20070293929 | Aoba | Dec 2007 | A1 |
20080167628 | Li et al. | Jul 2008 | A1 |
20080300667 | Hebert et al. | Dec 2008 | A1 |
20090105808 | Gerdts et al. | Apr 2009 | A1 |
20090254165 | Tabor et al. | Oct 2009 | A1 |
20090312829 | Aoba et al. | Dec 2009 | A1 |
20110264203 | Dwork et al. | Oct 2011 | A1 |
20110301702 | Rust | Dec 2011 | A1 |
20110313404 | Amos et al. | Dec 2011 | A1 |
20120095544 | Jeffrey | Apr 2012 | A1 |
20120203325 | Weisman et al. | Aug 2012 | A1 |
20130274870 | Lombardi | Oct 2013 | A1 |
Number | Date | Country |
---|---|---|
620320 | Feb 1992 | AU |
1112119 | Nov 1981 | CA |
3345612 | Jun 1985 | DE |
3919740 | Dec 1990 | DE |
41 15 007 | Nov 1992 | DE |
0 328 760 | Aug 1989 | EP |
0 388 112 | Sep 1990 | EP |
0 405 831 | Jan 1991 | EP |
0 505 686 | Sep 1992 | EP |
0 513 818 | Nov 1992 | EP |
0 792 657 | Sep 1997 | EP |
0 801 955 | Oct 1997 | EP |
1 059 954 | Dec 2000 | EP |
1 066 080 | Jan 2001 | EP |
1 156 847 | Nov 2001 | EP |
1867305 | Dec 2007 | EP |
2067454 | Jun 2009 | EP |
2133043 | Dec 2009 | EP |
2018600 | Oct 1979 | GB |
7-47133 | Feb 1995 | JP |
WO 9200775 | Jan 1992 | WO |
WO 9203963 | Mar 1992 | WO |
WO 9213589 | Aug 1992 | WO |
WO 9217236 | Oct 1992 | WO |
WO 9222345 | Dec 1992 | WO |
WO 9300126 | Jan 1993 | WO |
WO 9311826 | Jun 1993 | WO |
WO 9317750 | Sep 1993 | WO |
WO 9320882 | Oct 1993 | WO |
WO 9403213 | Feb 1994 | WO |
WO 9404216 | Mar 1994 | WO |
WO 9411038 | May 1994 | WO |
WO 9411047 | May 1994 | WO |
WO 9415549 | Jul 1994 | WO |
WO 9633764 | Oct 1996 | WO |
WO 9810820 | Mar 1998 | WO |
WO 9810821 | Mar 1998 | WO |
WO 9908740 | Feb 1999 | WO |
WO 9938557 | Aug 1999 | WO |
WO 9944667 | Sep 1999 | WO |
WO 9948552 | Sep 1999 | WO |
WO 9949808 | Oct 1999 | WO |
WO 9959664 | Nov 1999 | WO |
WO 0069498 | Nov 2000 | WO |
WO 0069499 | Nov 2000 | WO |
WO 0069500 | Nov 2000 | WO |
WO 0147591 | Jul 2001 | WO |
WO 02074378 | Sep 2002 | WO |
WO 2005053574 | Jun 2005 | WO |
WO 2011035318 | Mar 2011 | WO |
Entry |
---|
US 5,171,298 A, 12/1992, Walker et al. (withdrawn) |
Knecht, Gregory L., M.D. et al., “Double-Channel Fistulotome for Endoscopic Drainage of Pancreatic Pseudocyst”, Gastrointestinal Endoscopy, vol. 37, No. 3, May/Jun. 1991, pp. 356-357. |
Siegel, Jerome H., M.D. et al., “Two New Methods for Selective Bile Duct Cannulation and Sphincterotomy”, Gastrointestinal Endoscopy, vol. 33, No. 6, Dec. 1987, pp. 438-440. |
Number | Date | Country | |
---|---|---|---|
20120330397 A1 | Dec 2012 | US |
Number | Date | Country | |
---|---|---|---|
61501387 | Jun 2011 | US |